Research Proposal on "Evaluating Program Outcomes and Impacts"

Research Proposal 10 pages (2663 words) Sources: 6 Style: APA

[EXCERPT] . . . .

Costa Smoking Cessation

Smoking Cessation Intervention Amongst Costa Rican Adults

Tobacco use is one of the most deeply ingrained and consistently troubling public health concerns facing the world today. A substance with inextricable ties to commerce, culture and lifestyle, tobacco continues to invoke a set of mixed emotions amongst those engaged in the discourse over the hazards which it represents to health, environment and productivity. In this complex web of responses, there is present the opportunity to better understand a negative behavior pattern that has been so intricately woven into our collective instinct and to influence withdrawal from tobacco use or addiction by way of cassation programs. The fields of medicine and public health are mutually dependent upon one another but they tend to differ in one central capacity. With the former an admirable but largely reactionary science, it falls to those in the latter field to encourage preventative health behavior. Tobacco-use presents a great concern within this context. Nicotine addiction, itself a disease with extremely oppressive powers over the afflicted, is also a leading cause of high blood-pressure, heart disease, lung cancer and emphysema. In each is reflected a crucial point of concern to members of every race, class and ethnicity. Such is to say that tobacco use stands as one of the most dominant prejudices in the determinant of said conditions. This justifies an experimental program which attempts to establish the effectiveness of smoking cessation intervention through public health avenues in a developing sphere context.

Program Description:

Setting:

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One of the greatest challenges in stemming the tide of cigarette use and tobacco addiction is in addressing the methods used to induce tobacco dependency in the developing world. The study here focuses on Costa Rica, which is emblematic of the obstacles facing public health agencies where smoking is concerned in less developed nations. The reason for selecting Costa Rica is the apparent correlation between the comparably low cost of cigarettes there and the problem of addiction among Costa Rica's adults. Indeed, according to John (2008), "tobacco products in Costa Rica are much cheaper than in the United States and European nations. In developed countries, high taxation has been added to tobacco products to cover the increasing health costs incurred by national health systems. This practice has not yet been implemented in Costa Rica or other developing countries so they become prime markets for tobacco companies." (John, 1)

This represents a significant public health problem to the population of Costa Rica and imposes significant costs upon the universal health system of Cost Rica. According to John, "although the Caja Costarricense de Seguro Social (CCSS) has no specific data on the costs of treating lung cancer, in 2006, this organization spent about $61 million (¢30.489 million) to treat people with illnesses related to tobacco use (allergies, asthma, and cancer among others)." (John, 1) These realities have created a clear rationale for the study here conducted, which is intended to mitigate these conditions through intervention and smoking cessation programs.

Costa Rica is also an opportune place to conduct this intervention based on the resources which are readily availed by its public health system. The government funding of an array of primary care facilities dedicated to the purpose of health threat intervention helps to make this program feasible as well as desirable.

Service:

The intended services of the proposed study would be the cessation of smoking and a continued abstinence from smoking in its subjects. These two distinct phases of the project will indicate the need for two distinct measures relating to the cessation of smoking and the continued abstinence from smoking. The first service will affiliate with myriad therapeutic approaches during a 12-week program. The second service will affiliate with providing the strategies for independent abstinence from experiencing a smoking relapse. Both of these service goals are warranted by evidence that smoking cessation can have determinedly positive health outcomes even for those who have sustained a smoking habit for a lengthy duration.

To this end, all indications are that for those who are already smokers, there is a significant opportunity to improve life expectancy and health upon quitting and remaining tobacco free. According to the American Hearth Institute (AHA) (2009), "male smokers who quit between ages 35 to 39 add an average of 5 years to their lives. Female quitters in this age group add 3 years. Men and women who quit at ages 65 to 69 increase their life expectancy by 1 year." (AHA, 1) This is core rationale for the intended intervention and the focus of the services applied.

Target Population:

The mode for execution of this project would be through the various public health clinics in Costa Rica. Their service to their respective regions constitutes an outlet through which to access adult populations which are a fair representation of smoking patterns in their regions. In addition to providing demographic parameters through which to understand the backgrounds of participants, this may allow for an evaluation of differentiated responses based on regional and demographic characteristics.

Evidence suggests that the adult tobacco uses of Costa Rica have shown receptiveness to anti-tobacco intervention campaigns. To this end, Euromonitor International reports that "government organisations, such as the Ministerio de Salud (Health Ministry) and Instituto Sobre Alcoholismo y Farmacodependencia (IAFA - Institute of Alcoholism and Drug Dependency), engaged in anti-tobacco campaigns to increase awareness of the negative effects of tobacco. These had a damaging effect on the industry's performance." (EI, 1) This provides promise with respect to the target population and the intention of using public avenues to reach the appropriate individuals.

The focus here will be on adults, though smoking is a real health problem for individuals of all ages. Indeed, "according to the year 2000 National Census on Drug Use there are about 600,000 active smokers between the ages of 12 and 70 in Costa Rica." (John, 1) However, due to indications that adult smokers between the ages of 18 and 65 represent the best cross-section of individuals with tobacco addiction problems and simultaneously most likely to benefit from intervention programs, the program devised here would focus on adults only.

With respect to gender, indications are that an intervention would be best suited to meeting the interests of both men and women. This is because both constitute their own unique health risks in the area of tobacco use. To one end, "men make up about 74% of smokers in Costa Rica." (John, 1)

However, evidence suggests that women are coming increasingly to reflect the problems of smoking addiction in Costa Rica and particularly the costs imposed upon the healthcare system by related health threats. Accordingly, the John article reports that "the number of women with lung cancer doubled from 1993 to 2003. In a time span of 10 years, the percentage of female lung cancer patients went from 2.76 to 4.4 per 100,000." (John, 1) These two patterns help to construct a target of adult smokers, both male and female.

Intended Outcomes:

The intervention program is intended to promote the outcome of smoking cessation to be confirmed both six months and one year after the conclusion of the 12-month program. This outcome is warranted by published findings from the Centers for Disease Control, which promotes a smoking cessation agenda based on the recognition of its role in creating a widespread and costly public health crisis. The relationship between the promotion of public cessation programs and the success of individuals in quitting cigarettes is demonstrated by the research reported here and justifies the view of intervention as the primary area of need in addressing smoking addiction and its related health threats. According to Fiore et al., this need is also underscored by evidence of cessation education's importance as part of the fight against cigarettes. Fiore et al. indicate that "among smokers who had attempted cessation within the previous 10 years, 47.5% of persons who tried to quit on their own were successful whereas only 23.6% of persons who used cessation programs succeeded. We conclude that cessation programs serve a small, but important, population of smokers that includes heavier smokers, those most at risk for tobacco-related morbidity and mortality." (Fiore et al., 2760)

Logic Model:

The study will proceed upon a model of comparison with an equivalent group. This would allow for an observation of those treated by the intervention through the cessation program and those otherwise involved in the healthcare system but not engaging in the same program. Thus, each public health clinic would host a control and an experimental group, with the experimental group undergoing regular healthcare treatment alongside engagement in a cessation program. The control group would be made of smokers also engaging in regular healthcare treatment but not engaging in smoking cessation therapy programs. This approach is supported by the Bickman & Rog (2009) text, which indicates that "the various interventions that are applied to each group may eventually produce an important difference in the state of each group, the trial being designed so as to discern such a difference." (Bickman… READ MORE

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