Quantitative Methods for Social Health Research - Essay Example

Background: Recent research sought to research the possible link that exists between the type of packaging that is put on cigarette packetsand the intention to smoke. This study aimed to add on to this research by examining the impact of plain packaging and intention to smoke among international students. Some studies have found that making these packets plain impacts positively on the intention of a person to smoke especially if the health warning can clearly be seen. Method: The present study made use of a cross sectional study design to analyze the relationship between plain packaging and the intention of international students to smoke. A convenience sampling strategy was used to choose 30 participants from Adelaide Universities who were required to fill out a self administered questionnaire. Results: Participants were male in gender (100%) and largely drawn from the age bracket of between 25 and 29 years (53.3%). The large majority of the participants (56.7%) lived with their family which was interesting considering 83.3% of the respondents had smoked cigarettes while 16.7% had not. Conclusion: Results from the current study found a significant link with plain packaging and the intention of international students to smoke (r=8.878, p=0.51) and the influence of friends who smoked on the student’s desire to either begin or continue smoking (p=.530). It was also found that international students who have difficulties with studying will not be likely to show an increase in smoking(r=3.406, p=0.527). Additional research will need to be carried out to determine the impact that branding has on the intention for a smoker to either begin smoking or to continue especially in the context of international students who often have trouble with understanding the language of the countries they now live in. Background literature review Cigarette smoking has negative implication on the health of a person. Nevertheless, despite being aware of the effects of smoking, finds it hard to quit the habit. Governments have devised mechanisms of minimizing the amount of cigarette smoked with several measures including plain packaging of cigarette. Plain packaging of tobacco is a packaging that requires removal of all branding and only requires the manufacturer to print a brand name in mandated size in addition to a health warning to help in drawing the smokers’ attention more to the health warning. In relation to the 2010 statistical figures by Australian institute of health and welfare 2010, there is a significant reduction in daily smoking by 15% since 2007. However, it is still necessary to understand the impact of plain packaging of cigarette on the smoking habits to specific groups like the international students (Moodie & Ford, 2011). The 2014 statistical figures by the Australian Bureau of Statistics (ABS) (2014), indicates that the total consumption of tobacco in March 2014 was the lowest ever recorded, with the tobacco clearance falling by 7.7 percent in 2014 relative to 2013.According to the ABS, the fall in the figure of smoking is related to plain pack cigarette packaging developed by the parliament. In relation to international students, a qualitative study involving focus group by Moodie and Ford (2011) indicate that the influence of plain cigarette packaging depends on the smoking level of a person. For an addict, plain packaging has a little impact while, for a starter, the packaging would draw attention to the health warning. However, a different randomized study by Hammond et al. (2009)indicate that plain packaging of cigarette has a positive impact towards cessation of smoking. This study, though does not categorically address the issue of international students, points out that the attention of people are often drawn to rules, thus will make them get the health information on the plain pack cigarette in comparison to the conventional packages. A randomized controlled trials experimental study found that branding has a significant influence on the development of a smoking habit (Germain et al. 2010). In addition, a randomized control trial study conducted by Volpp et al. (2009) points out that in the initial moments of smoking, a smoker reports pleasure and stress reduction, which would encourage one to continue with the habit. Maynardet al. (2013) in an experimental study using mixed model experimental design in Bristol asked their participants to look at twenty images of cigarette packs on a computer screen for ten seconds each, with a device tracked their eye movements. The study involved a convenience sample of adolescents comprising never-smokers (n=26), experimenters (n=34), weekly smokers (n=13) and daily smokers (n=14). The measurements of the study were the number of eye movement to health warning and branding. In the images, 10packswereplain, while10weretheconventionalpacks.Thestudentswhowere non-smokers paid attentions to health warnings on both packets. The smokers avoided all health warnings, while occasional smokers paid more attention to plain packs than those on the branded ones. The findings indicate that plain packaging of cigarette attracts more attention to the health warning than those of the branded ones, thus can influence the smoking habit (Maynard et al. 2013). Development of smoking habit can be associated to social learning theory (Bandura & McClelland 1977). According to Albert Bandura, social learning is a cognitive process that takes place in a social context through observation or direct instruction without the need for reinforcement. This study will be using statistical inferences indicating that the development of a habit can be socially learned through interaction with others as well as interaction with print Medias such as health information on a cigarette pack, similar to a randomized control trial study conducted by Mukherjee et al. (2013). According to Amiaz et al. (2010), learning is a cognitive process that takes place within a social context. Learning can take place through observation or by direct instruction. Development of smoking habit in the same nature as the social learning process can occur by observation of cigarette related behaviour of others as well as publicity features of cigarette. The presence in the gaps within prior studies conducted (Hammond et al. 2009 and a cross sectional study by Kusma et al. 2010)delineates a need for further research to study the possible correlation between plain packaging of cigarette on smoking intention for international students. This study found that the ability to concentrate on the health warning on a plain packed cigarette had a positive influence towards the cessation of smoking. The study was founded on the social learning theory which posits that learning is a process that is cognitive in nature and can take place within a social context either through learning or observation. The conduction of this study aimed to investigate the research question: Does plain pack cigarette packaging impact smoking intentions for international students? It was guided by three key hypotheses: 1. International students who perceive plain packaging as effective will be less likely to smoke, compared to international students who perceive plain packaging as ineffective, 2. International students who report high levels of study difficulties will report an increase in smoking and 3. International students who observe their friends smoking are more likely to smoke through their interaction. Methods Study Design The study employed a cross sectional study design. A cross-sectional study design is a kind of observational study involving analysis of data collected from a population or a representative subset. The study employed the use of a cross-sectional study design since it sought to determine knowledge and attitude of the participants towards the usage of tobacco in a plain pack. The design therefore purposely allowed the study to determine whether plain packaging of cigarette diminishes smoking intention among the international students or not. The use of a cross sectional study design provided the strength of ensuring adequate sample was reached. Working with adequate sample increases validity and reliability of the study. Nevertheless, the design has a weakness in that, it may be impossible to survey the entire population of interest and often rely on secondary collected data (Morton et al. 2012). Participants and sampling The study targeted 30 international students who were the participants of this study. Based on the study objectives, all international students in Australia were eligible participants of the study. With the study participants, the research sought to uphold the ethical considerations of justice, beneficence and respect by ensuring that the participants properly understand the intention of the research before inclusion into the study. This studydrew on a convenient sampling as the preferred sampling method. The use of convenient sampling ensured that the study benefited from inclusion of relevant respondents and minimized on participant time burden that might have resulted from sampling irrelevant participants (Barreiro &Albandoz 2001). Measures The study made use structured questionnaires as the tool for data collection. The data collection tool was divided into two core sections with the first section presenting information about the social-demographic status of the participant and the second section addressing plain packaging of cigarette. Different types of questions were used in the questionnaire including the Likert scale questions, the multiple-choice questions and the descriptive questions. The use of multivariate nature of questions in the questionnaire was done to capture the attitude and knowledge of the participants on plain packaging of cigarettes. The questions in the questionnaire were developed based on theory and existing literature. The use of questionnaires as a measure in the study was necessary for the generation of descriptive data, which was subsequently used to quantify the proportion of plain packaging of cigarette on smoking intention. Using a well-developed questionnaire that categorically answer ether research hypothesis helped in increasing validity and reliability of the survey tool (Bruce et al. 2008). Data Analysis Data collected from the questionnaires was coded in a manual manner and put into SPSS which is a statistics program. SPSS was then used to come up with descriptive statistics of all the data that had been collected. These statistics were used to provide a description of the age and gender of the sampled population, their level of education, current relationship and smokers and non smokers. A hypothesis test was also done in an effort to make a clear determination of the importance of the data collected to the hypotheses driving the study. In this particular instance, a test for correlation was done to find out if a link existed between plain packaging of cigarette packs, study difficulties and peer influence and the amount of smoking that an international student will engage in. Results Participants from the study were gathered from three universities in Adelaide (Flinders University, Adelaide University and University of South Australia). Thirty participants (n=30) voluntarily engaged in and completed the questionnaire with 100% being male as shown in table 1. The large majority of the sampled population were between the 25-29 year age bracket at 53.3% and 23.3% were aged between 30-34 years. The fact that males between 25 and 29 years participated in the study might impact on the results since males are far more likely to participate in smoking. Table 1: Frequency of Gender Gender Frequency Percent Valid Percent Cumulative Percent Valid Male 30 100.0 100.0 100.0 Table 2: Age of Respondents age of respondents Frequency Percent Valid Percent Cumulative Percent Valid 20-24 6 20.0 20.0 20.0 25-29 16 53.3 53.3 73.3 30-34 7 23.3 23.3 96.7 more than 35 1 3.3 3.3 100.0 Total 30 100.0 100.0 It is important to note that the variables used in the study were categorical in nature and independent however, the fact that the observations were less than five led to the use of Fischer exact test. Majority of the participants were from college at 56.7% of the sampled population (n=17), whereas 56.7% of the participants who took part in the study lived with their family. Very few participants (16.7%) reported not being smokers as opposed to 83.3% of the respondents who admitted that they have smoked a cigarette. Testing of the first hypothesis was done using Fischer’s exact test and tested two variables. Two assumptions were made in testing of the first hypothesis; the link between plain packaging, health warning and the likelihood of smoking and the second assumption being observation of clear health warning and ability to change one’s mind regarding smoking. The result provided a p-value of 0.51 showing that international students who viewed plain packaging as effective were not any likely to smoke (p=0.51) which is interesting considering there was no correlation found between the study difficulties of international students and their likelihood of smoking(p=0.527). An examination of the third hypothesis was done using the Kruskall-Wallis test and comparison was made between three groups. The assumptions in this instance was the number of cigarettes smoked in a day, the perception that a friend was smoking and the observation of the use of cigarette smoking and interaction with those who smoke. A p-value of .530 was found which was interesting considering that 20% of the respondents lived with their friends. This was statistically not significant for the hypothesis which was found after an analysis was done of the two independent samples. Table 3 represents the scores of individuals who smoked and those who did not. Of the individuals who took part in the study, 12.2 of 30 agreed that observation of clear health warnings did impact on the number of cigarette packs that they smoked, 6.2 of 30 of those who smoked two or more packs agreed that clear health warnings did affect their need to smoke and 6 out of 30 were of the opinion that observation of clear health warnings did not impact on their decision to continue smoking. collapsed smoking * Observation of clear health warnings in a cigarette pack would make you change your mind towards smoking Cross tabulation Observation of clear health warnings in a cigarette pack would make you change your mind towards smoking Total Strongly agree agree Disagree collapsed smoking no cigarette Count 3 2 1 6 Expected Count 2.0 2.6 1.4 6.0 less than 1 pack a day Count 6 9 1 16 Expected Count 5.3 6.9 3.7 16.0 one or more packs a day Count 1 2 5 8 Expected Count 2.7 3.5 1.9 8.0 Total Count 10 13 7 30 Expected Count 10.0 13.0 7.0 30.0 Discussion The results from the study provide evidence that plain packaging on cigarettes has an impact on the intentions for smoking that international students have. The hypothesis that having difficulties in study would positively increase the levels of smoking was provided support by the results of the study. In addition, having friends who smoke do significantly influence the extent to which an international student will turn to smoking. This links into the social learning theory argument that people can learn a certain type of behaviour, in this instance smoking, when they are surrounded by people who smoke. The findings from this study are in direct contrast with those put forward by Moodie and Ford (2011) who found that plain packaging does not have any significant influence on the smoker however, it defers from the present study in that it considers the level of smoking that one is at. Similar to this study, Moodie and Ford (2011) collected data from international students and found evidence, similar to that which was found in this study that a smoker who was just beginning would be drawn to the health warning on the package. The study by Moodie and Ford (2011) is aligned with social learning theory where the individual would choose not to engage in smoking through perceiving that the consequences would be negative. These findings are supported by Hammond et al (2009) who found that the type of packaging adopted plays a significant role in ending smoking. It is however important to note that Hammond et al(2009) did not specifically examine international students and therefore presents some difficulty with regard to comparison with the present study. Volpp et al (2009) found a positive correlation between the type of branding strategy adopted and the impact on the individual smoker in terms of developing his smoking habit. However, the present study provides results that are conflicting and this could have been as a result of the fact that Volpp et al (2009) examined the initial stages of smoking and how these feelings impact on whether one will continue smoking, an aspect that was not examined in the questionnaire that collected data for this study. The Volpp et al (2009) study also placed focus on aspects of pleasure and reduction of stress which would play a role in encouraging the habit while the present study only investigated the impact of packaging and the impact that it plays on the smoking habits of individuals. This is in line with the contention of social learning theory that an individual’s behaviour is driven by motivation which in this instance would be the reduction of the amount of stress that an individual feels (Volpp et al, 2009). The aspect of branding was examined by Maynard et al (2013) who found a significant correlation with plain packaging and attention to health warning which in turn can lead to a significant influence on the smoking habits adopted by individuals. In particular the results found in the study carried out by Mukherjee et al (2013) present a more specific indication of the impact of health information on a cigarette pack. In addition, the findings of the study are consistent with the assertion by Amiaz et al (2010) that behaviour that is related to cigarettes can be learned from observing others in line with the fact that learning is a process that is cognitive in nature as set forward in Social Learning Theory. Strengths and Limitations There might be a number of explanations for why there is some inconsistency in terms of the results that are found in the study with that of other studies examined. Even though the use of a cross sectional study provided the chance for the researcher to collect a large amount of quantitative data without incurring any significant expenses, the use of a longitudinal study as a way to analyze the long term links that exist within the research question would have had the potential to ensure that the results would have had more significance (Nardi, 2014). The reliability of the questionnaires might be responsible for some of the inconsistencies that accompany some of the data that was collected especially when a comparison is made with other studies (Bruce et al, 2008). In addition, the study used a small size and adopted a strategy of convenience sampling which might not be helpful in providing a representation of the entire population. Further studies need to be carried out in an effort to comprehensively examine the impact of packaging on the smoking desire of international students (Esch et al, 2006). Conclusion A large amount of research has been taken on to examine the potential impact that branding has on the smoking behaviors adopted by international students. Many of these studies have identified plain packaging as a conducive factor for individuals to stop smoking. The present study explored the link that exists between plain packaging and international students desire to smoke with the results indicating that there is a link between the two aspects. The large majority of those surveyed were aged between 25 and 29 years which shows that other ages might not be as involved in smoking as those in this age group. Additional research needs to be carried out to examine the impact of plain packaging since this will provide a bigger chance for individuals to indulge less in smoking (Zboja & Voorhees, 2006). References Australia Bureau of Statistics.2014, ‘Prevalence of smoking-adults’, pp. 3-10. Australian Institute of Health and Welfare. 2010, ‘National Drug Strategy Household Survey: survey report’, Drug statistics series no. 25, AIHW cat. no. PHE 145. Canberra: AIHW, 2011. Amiaz, R, Levy, D, Vainiger, D, Grunhaus, L & Zangen, A 2009, Repeated high‐frequency transcranial magnetic stimulation over the dorsolateral prefrontal cortex reduces cigarette craving and consumption, Addiction, vol. 104, no. 4, pp. 653-60. ADR Research committee 2011, ‘Cross-sectional study design. American dietetic association’. Bandura, A & McClelland, DC 1977, Social learning theory. Barreiro, PL & Albandoz, JP 2001, Population and sample. Sampling techniques, Management Mathematics for European Schools MaMaEusch (994342-CP-1-2001-1-DECOMENIUS-C21. Bruce, N, Pope, D & Stanistreet, D 2008, Surveys, in Quantitative Methods for Health Research, John Wiley & Sons, Ltd, pp. 129-91. Control, CsfD, Prevention & America, USo 2008, Morbidity and Mortality Weekly Report, Morbidity and Mortality Weekly Report, vol. 57, no. 29, pp. 793-816. Esch, F., R., L. Tobias, S.H. Bernd and G. Patrick, 2006. Are brands forever? How brand knowledge and relationships affect current and future purchases. J. Prod. Brand Manage., 15(2): 27-49 Germain, D, Wakefield, MA & Durkin, SJ 2010, Adolescents perceptions of cigarette brand image: does plain packaging make a difference?, Journal of Adolescent Health, vol. 46, no. 4, pp. 385-92. Hammond, D, Dockrell, M, Arnott, D, Lee, A & McNeill, A 2009, Cigarette pack design and perceptions of risk among UK adults and youth, The European Journal of Public Health, p. ckp122. Kusma, B, Quarcoo, D, Vitzthum, K, Welte, T, Mache, S, Meyer-Falcke, A, Groneberg, DA & Raupach, T 2010, Berlins medical students smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling, Journal of Occupational Medicine and Toxicology, vol. 5, no. 1, pp. 1-10. Maynard, OM, Munafò, MR & Leonards, U 2013, Visual attention to health warnings on plain tobacco packaging in adolescent smokers and non‐smokers, Addiction, vol. 108, no. 2, pp. 413-9. Morton, S, Bandara, DK, Robinson, EM & Carr, PEA 2012, In the 21st Century, what is an acceptable response rate?, Australian and New Zealand journal of public health, vol. 36, no. 2, pp. 106-8. Moodie, C & Ford, A 2011, Young adult smokers’ perceptions of cigarette pack innovation, pack colour and plain packaging, Australasian Marketing Journal (AMJ), vol. 19, no. 3, pp. 174-80. Mukherjee, A, Mishra, SK & Ray, S 2013, Cigarette Smoking and its Concomitants: A Study among the Young Adults of Kolkata, India, The Oriental Anthropologist, vol. 13, no. 1, p. 89. Nardi, PM 2014, Doing survey research: A guide to quantitative methods, 3rd ed, London. National Health and Medical Research Council 2015, National statement on ethical conduct in human research. Australian research council. Volpp, KG, Troxel, AB, Pauly, MV, Glick, HA, Puig, A, Asch, DA, Galvin, R, Zhu, J, Wan, F & DeGuzman, J 2009, A randomized, controlled trial of financial incentives for smoking cessation, New England Journal of Medicine, vol. 360, no. 7, pp. 699-709. Zboja, J.J. and C.M. Voorhees, 2006. The impact of brand trust and satisfaction on retailer repurchase intentions. J. Serv. Mark., 20(5): 381-390  Appendices Appendix 1: Questionnaire Impact of plain packaging of cigarette on smoking intention of international students Instructions: Use a tick or a circle to indicate your preferred answer 1. Gender Male Female 2. How old are you[_____] years 3. Highest level of education: Secondary College/UniversityTAFEDiploma 4. What is your current relationship status? Single Separated MarriedDivorced In relationship 5. Whom do you live with? Family Friend Dorms Alone 6. Have you ever smoked cigarette? If No go to question 8.Yes No 7. If yes in 6 above, how many cigarettes do you smoke per day? 7a: PLAIN PACKAGING Not even 1 cigarette N/A Less than one packet in a day One packet in a day More than one packet in a day Others (Specify) ………… 7 b: OTHER PACKAGING WITH HEALTH WARNINGS Not even 1 cigarette N/A Less than one packet in a day One packet in a day More than one packet in a day Others (specify) 8. Tick which is your hindrance factor towards smoking? a) Pricing of plain pack cigarettes b) Your education level c) Health implications of cigarette smoking d) Advice from friends/relatives against smoking e) I would want to conform to rules f) Smoking is expensive 9. Do you buy or roll your cigarettes? Buy Roll 10. Plain packaging of cigarette is effective way of smoking prevention. On scale 1- 7 how much do you agree with that statement? Please circle the number that represents your level of agreement with each statement. SD = Strongly Disagree, D = Disagree, A = Agree, SA = Strongly Agree SD D A SA Plain packaging of cigarette is effective way of smoking prevention. 1 2 3 4 5 6 7 Instructions: Use a tick or a circle to indicate your preferred answer to these statements. Strongly Agree Agree Disagree Strongly Disagree Observation of clear health warnings in a cigarette pack would make you change your mind towards smoking. It reminds about the effects of smoking Causes respiratory infections Smoking is expensive Causes cancer of the lungs Nothing is wrong with smoking 11. Being an international student, tick whether you agree with the following statements about study difficulties influence smoking intentions? Strongly Agree Agree Disagree Strongly Disagree Study difficulties increases the need to take up smoking Study difficulties has an impact on me to think about smoking as a necessary habit Smoking can help me to focus on my study commitments. International students have more study difficulties which encourage them to smoke with friends. 12. Do you think there is a better method of influencing smoking cessation as opposed to plain packaging of cigarette? Yes No 13. How important would you rate the method and influence of plain packaging of cigarette towards smoking cessation in Australia on a scale of 1-7 Not at all Important Moderately Important Extremely Important 1. Plain packaging publicity has been very successful for my smoker friends. 1 2 3 4 5 6 7   2. Plain packaging publicity has had no impact on my choice of friendship groups. 1 2 3 4 5 6 7 3. Plain packaging has led to a slow decrease in the smoking habit among my friends. 1 2 3 4 5 6 7   4. Observing the use of cigarette smoking has led to my continued interaction with friends who have a smoking habit. 1 2 3 4 5 6 7 14. Being an international student, would you advocate for plain packaging of cigarette in your friendship group? Yes No Thank you for participating in thissurvey. Read More