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Assignment extract:

Essay 1500 words
Select an epidemiological study that has been published in a peer-reviewed journal in the past 10 years:
1. Summarise the study (300 words) and critically evaluate using an appropriate critical appraisal tool (700 words). (100 words total; 60% of marks).
2. Using a style appropriate to a lay audience (for example, newspaper readers), outline the public health and/or health promotion implications of this study (500 words; 40% of marks).


Article Summary

The article is an epidemiological study in Japan. The review is a focus on the relationship between smoking, especially cigarettes and the risk of type 2 Diabetes Mellitus (T2DM) in the country. The study was developed in the backdrop of an understanding that the rate and percentage of smokers in Japan remains high in proportion to the overall population. Although the percentage of smokers has declined, the decline rate is not big enough and thus a majority of the Japanese citizens remain smokers. The study investigated the three elements of smoking including the status (smokers or non-smokers), the intensity of smoking (the frequency of smoking and number of cigars smoked on a daily basis), and cessation (the extent of quitting and the number of years since quitting) (Akter, Goto & Mizoue, 2017). The study used the existing MEDLINE and Uchushi databases to get the relevant articles and acquire a qualified sample base in the context. The review used a statistical analysis approach to review the relationship between the variables.

It established that there exists a relationship between smoking and the risk of T2DM among the populace. As such, over 18.8% of the men T2DM cases were linked to smoking while 5.4% similar cases among women were linked to smoking. Moreover, it was also noted that the process of quitting smoking was related to reducing risk exposure to T2DM. As such, the risk of exposure to the illness remained high for the first 5 years preceding quitting but the risk decreased to the level of non-smokers after 10 years of quitting. Thus, smokers who quit smoking for over 10 years were categorised to be within the same risk bracket and exposure category with the non-smokers. The article concluded by affirming the hypothesis that there is a direct positive relationship between smoking and exposure risk to T2DM (Akter, Goto & Mizoue, 2017).

Article Appraisal

The article under review is a peer-reviewed article. This means that prior to its publication; the article had been evaluated for accuracy and relevance by a panel of experts. Consequently, this appraisal does not seek to invalidate any part of the content of the article. Instead, it seeks to explore on the weakness and strength areas of the article methodologies, as well as the systems and processes applied in arriving at the user data. In the process of appraising the article, this review applies the strength and weakness analysis model (Pan, Wang, Talaei, Hu & Wu, 2015).


One of the major strengths of the article and its findings is on the applied and used source of data for the review. Overall, the review used a sample base of two credible databases. In this case, the review used both the MEDLINE and Uchushi databases. These are databases with credible medical records and files for patients. The fact that the study findings relied on the data obtained from these databases increased the possibility for the accuracy of the obtained findings (Sattar et al., 2015). The databases have a large pool of information that could have been relied upon in formulating the findings. This is actually the basis through which the study large sample base was obtained from. In this case, through a perusal of the database, it was possible to identify over 22 eligible articles that contained over 343,573 subjects and of which 16,383 were T2DM patient. This meant that the study had a large and enough sample bases to evaluate the different study variables.

Additionally, the use of secondary data ensured that the study would evaluate data longitudinally. Its focus was not only on the relationship between the variables of smoking and T2DM but also on the effect of quitting smoking and the exposure risk over time. Consequently, it was imperative for the study to observe the characters and the exposure risks of the patients and the subjects' overtime (Taylor, Davies & Munafo, 2015). This was estimated for a 10 years period of time. In the case of using primary data, the evaluation of a ten years longitudinal process would not have been viable. This is because the study would have taken 10 years to develop findings. Consequently, the use of an accurate database provided an opportunity for the review to analyse the data over the last 10 years (Bilano et al., 2015). This was the bases through which the relationship between quitting years and exposure to 2TDM was developed.


Although the study use of secondary data was vital in offering a longitudinal analysis, it has its share of weakness. On the one hand, the use of secondary data meant that the review relied on a sample base that the reviewers and authors lacked control over. Consequently, the risk of errors in the initial 22 eligible articles used could be relocated in the eventual study findings developed. Thus, the risk of the article is that it is as accurate as the each and every one of the sued 22 articles. The fact that it lacks the ability to guarantee the credibility and accuracy of the data and findings used, besides citing the credibility of the user databases weakness the study findings effectiveness (Uchimoto et al., 1999).

The second weakness area in the developed article was in the distribution of the contents of the articles. In this case, there were two ain aspects evaluating the relationship between smoking and 2TBM, and the impact of cessation years on the exposure risks (Willi, Bodenmann, Ghali, Faris & Cornuz, 2007). It would have been therefore expected that the study articles would be distributed across the two evaluation issues. However, the study selected articles were more focused on the smoking relationship to 2TBM. In this context, 19 studies were on the current smokers and their exposure to the illness. However, only 3 articles were oriented towards the cessation years. This is a very small article and database through which the decision on the impact of cessation years on the risk of exposure to 2TBM (Facchini et al., 2012). Therefore, although the eventual conclusion of the context was developed, this was not sufficient enough and raises a credibility of the findings question. The major weakness area and arising research question are on whether the use of a wider scope of articles would result in differing results and conclusions' on the issues. Nevertheless, despite the weakness areas, the strengths of the article outweigh the weakness areas implying that it is a strong and reliable literature base.

Health Issue

The health issue at hand is the type 2 diabetes mellitus illness. This is a rising cause of concern not only in Japan but globally. In the past, Diabetes was closely linked to old age. In this case, as the insulin production in the ageing declined, they were increasingly exposed to the risk of T2DM. However, this content has since changed (Attvall, Fowelin, Lager, Schenck & Smith, 2013). Currently, the risk of exposure to diabetes mellitus has expanded to include both the aged and the young equally. One of the core emerging aspects in the rise of the illness is that it is closely related to the social lifestyle. For instance, in the case of smoking, it was established that at least 18.8% of men with T2DM were smokers and smoking was directly linked as the cause of the illness.

This means that smoking has an impact on both the society and the government at large (Van der Vaart et al., 2004). On the one hand, this has reduced the society economic capability as those ill are unable to optimally function and as such denting their economic performance progress. On the other hand, it equally has an impact on the government. This is the disease burden. A disease burden bestows the responsibility of the government on ensuring that disease prevalence is reduced and the existing illness cases are catered for. In the case of the Japanese government, the burden is in the form of caring and ensuring that the right medication is available to the patients. Additionally, it weighs on the government to institute proper systems and structures that ensure that the risk of prevalence and new illness contracting are reduced into the future.

Based on the article findings, there are three probable outcomes and implications of the review findings. The first such an outcome is an increased public awareness’ on the negative effects of smoking and the value of cessation (Chowdhury, Rayford & Chang, 2008). In this regard, the article demonstrated that although the risk of exposure was high in the first 5 years preceding quitting smoking, the risk decreased substantially at 10 years, equalling those of non-smokers. This, this will increase the hope and motivation by the current smokers to quit smoking in the hope that after 10 years their risk of exposure would be as low as for the non-smokers. Secondly, the implication of the review is on government increased focus on regulating smoking. It is evident that smoking increases the disease burden in the nation (Barrett-Connor & Khaw, 2009). The most probable government action would be to increase the tax rates on the cigarettes as well as the starting up of rehabilitation programs. Such programs would help and motivate those willing to quit smoking on their recovery journey. Thus, the government will not place more emphasis and focus on reducing smoking rates in the nation.



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