Systematic Review and Meta Analysis

Discuss about the Systematic Review and Meta Analysis.

The government of New Zealand recognises tobacco smoking is considered as a global health problem. Research estimates suggest that tobacco smoking contribute to more than 5000 deaths every year. Moreover, they have been considered as the major reason that contributes to disparity and inequalities in ethnic and socioeconomic sectors (, 2018). Smoking is regarded as a public health issue because it contributes to preventable ill health, disabilities and premature death among the active and passive smokers (Murray & Lopez, 2013). According to research evidences, cigarette smoke is found to contain more than 7000 chemicals, which upon inhalation makes the person more vulnerable to getting exposed to a range of toxins. These toxins are primarily found to contain various tobacco constituents and pyrolysis products (Reynolds, 2013). The short-term effects of cigarette smoking lead to a diminished health status of all smokers and also act as biomarkers of physiologic disadvantage.

Tobacco consumption has also been linked to acute respiratory symptoms and increased susceptibility to a range of illnesses. Furthermore, long-term effects of smoking are associated with development of cancer, coronary heart disease, and chronic obstructive pulmonary disease (Jha & Peto, 2014). Statistics suggest that around 15.7% adults are current smokers and the number has reduced from 20.1%, as estimated in the year 2007. Furthermore, the government also indicates presence of smoking in 35% Maori adults and 24% Pacific adults (Ministry of Health NZ, 2018). The assessment will focus on Ms. Veronica Jones, a 45 year old schizophrenic patient who requires frequent hospitalizations due to her mental health condition. The patient has been found to report an interest in smoking cessation.

The patient suffers from schizophrenia, which can be defined as a mental condition that is characterized by abnormalities in social behaviour and a failure to understand reality. The government considers such a population suffering from schizophrenia to be extremely vulnerable to smoking due to evidences presented by various meta-analysis that have correlated an increased likelihood of schizophrenics to smoke. According to the socioeconomic/environmental hypothesis, most individuals suffering from schizophrenia are found to be unemployed and inactive. Thus, they resort to smoking for relieving their boredom (Gronlund, 2014). Furthermore, the personality hypothesis suggests that schizophrenia often accounts for anxiety symptoms and high levels of neuroticism among the patients that lead to development of tobacco consumption (Iasevoli et al., 2013). Furthermore, research investigations have established a strong correlation between volume reduction in the dorsolateral prefrontal cortex and the hippocampus, among schizophrenia patients. Smokers have been found to demonstrate significantly lower DLPFC and hippocampal volumes, upon comparison to non-smokers. A 2.2-2.8% reduction in the volume of gray matter provides evidence for prevalence of smoking habits among schizophrenics.

Furthermore, recent research studies have confirmed prevalence of smoking habits among 80% people with schizophrenia. These rates are three times higher than the national average rates. These studies also established the fact that nicotine exerts positive effects on the cognitive faculties, thereby improving cognitive function. Isolated nicotine has been proved effective for brain enhancements (Durazzo, Meyerhoff & Nixon, 2013). This acts as probable evidence for higher rates of smoking among individuals who suffer from similar schizophrenic symptoms as the patient Veronica. Moreover, rates of higher smoking among schizophrenics can also be attributed to the fact that nicotine is used by the individuals to compensate for their cognitive deficits, which occur as a direct manifestation of schizophrenic symptoms (Lerman et al., 2014). Furthermore, the mental health foundation of New Zealand also identifies the evidences that suggest strong association between anxiety and stress and the risks of developing mental illnesses such as, schizophrenia. Furthermore, smoking cessation has also been found to diminish anxiety and stress, thereby reducing rates of panic attacks, suicidal ideations, and other abnormal behaviour (Waterhouse et al., 2016). In addition, findings have also correlated effects of smoking cessation on reducing vulnerability of cognitive and intellectual decline, thereby contributing to an increase in vitality, and enhancing the overall health and wellbeing of the patients (Featherstone & Siegel, 2015). Thus, the collective benefits of smoking cessation programs have been found to mark the overall improvement in quality of life of all individuals with schizophrenia. The aforementioned efforts have resulted in the Ministry of Health to adopt intervention and smoking cessation techniques for the target population (van der Deen et al., 2014). This has paved the way to collect evidences on administration of appropriate pharmacological principles that have shown significant success in improving short-term and long-term abstinence rates among the individuals. Thus, the identified population group, has been selected as a priority, upon which smoking cessation programs will be implemented.

Health education plans refer to specific documents that contain exhaustive description of the health, educational and social care needs of an individual. These plans are formulated in way that will help in increasing awareness on the major health problem that has been identified. Most often smokers and other tobacco users are unaware of the underlying factors that create a significant impact on smoking cessation or might fail while trying to quit smoking. Thus, creating a smoking cessation plan that addresses the preferences and demands of the target population will increase their chances of stopping tobacco consumption and will also help in motivating them and identifying appropriate coping strategies (Biener & Hargraves, 2014). Cultural safety refers to an effective nursing practice that is determined by taking in considerations the preferences and beliefs of the service users. Hence, the smoking cessation plan will be built in a way that does not demean the cultural identity of the patient, Veronica. The primary step will be to inquire about smoking habits and its frequency upon admission to the mental ward of a hospital unit. This will be followed by conducting a thorough physical assessment of the client that will help in determining any abnormality in the vital signs that can be linked to smoking habits (de Vries, Eggers & Bolman, 2013). Adequate time will be given to the client to reflect on the smoking status. While developing a health education plan to assist Veronica to adopt a successful smoking cessation program, primary efforts must be taken to help her understand the ill effects of smoking on her physiological and mental system. Each individual has unique reasons for quitting smoking. An analysis of the case scenario suggests that Veronica has decided to take attempts for quitting smoking to save her financial expenses. Thus, the education plan must primarily focus on reminding the patient to know about the potential adverse effects of smoking on the overall health and quality of life (Taylor et al., 2014). This will inspire her to stop smoking for good. The plan will maintain appropriate cultural safety by putting an emphasis on the health gains and wellbeing of the patient. The practices and beliefs of the patient will also be acknowledged. Further cultural safety aims will be related to empowering the patient regarding her decision to use the smoking cessation service.

The effects of smoking on health and appearance will be explained to the patient, by emphasizing on the increased chances of suffering from cancer, heart attacks, strokes, cardiovascular diseases and respiratory troubles. Relevant educational materials will be provide to support the statements. Owing to the fact that the client wants to save money, the health education plan will illustrate the role of smoking quitting on lifestyle of individual smokers. Efforts will be taken to demonstrate probable benefits of smoking such as, having more money to spend, getting more time to spend with family, and less worries about smoking (Zwar, Mendelsohn & Richmond, 2014). Mental disorders such as, schizophrenia are most commonly manifested by experiences of delusions or hallucinations that begin to interfere with family life and daily chores. Failure of such patients to seek appropriate employment opportunities creates financial burden and often disrupts family life. Thus, the health education plan will be successful in making the target population realize reasons that they might have not considered earlier. Measures will also be taken to understand the impact of the proposed care plan in the form of a bearer of her history, culture, life experiences and attitudes. All kinds of efforts will be taken to resolve conflicts or tension between the culture of the care centre and that of the patient. An understanding of the rights of the patient will also be gained, before delivery of care services. The plan will also include provisions of printable tobacco intervention cards that will contain descriptive information on tobacco interventions that should be adopted by the client, as well as the target population (Siu, 2015). These cards will contain details of resources that can be utilized by the target individuals when they are ready to quit smoking. Information for direct referrals must be provided that will assist the patient in quitting. If the client is not ready to quit, the intervention card will strongly encourage them with the use of personalized messages and use of mHealth applications (Buller et al., 2014). Effective communication will be ensued to discuss about the concerns of the client regarding quitting and the probable ways of dealing with them will be illustrated. The health education plan will also provide resources related to smoke free campaigns, schizophrenia support organizations, and text-messaging programs for suicide prevention, text-messaging program for smoking cessation, and government helpline numbers for the same. Further efforts will be taken to assess readiness of the client to quit smoking.

Owing to the fact that the client Veronica decided that she was ready to quit. Thus, the health educational plan will contain provisions for explaining the importance of brief counseling services and appropriate medications such as, varenicline, buproprion, and clozapine. Longer appointments might be necessary to assess nicotine dependence, previous quitting history and co-morbidity (Evins et al., 2014). The clients will be made to adhere to these drugs owing to their antipsychotic role that will help in reducing symptoms of schizophrenia. Further efforts will be taken to describe action of these drugs in facilitating abstinence from smoking symptoms. Care should be taken to reduce the dosage of the drugs such as, clozapine and olanzapine after the target individuals successfully quit smoking. This can be attributed to the fact that the blood levels of these drugs are found to increase after smoking cessation. Optimistic support will be provided to encourage the clients to seek help from friends and family (Nayan et al., 2013). Assurance will also be provided regarding relapses. Thus, there is a need to reduce the drugs by approximately 35%.

The education plan will also involve providing the clients a sound understanding of the side effects or complications that can arise due to cessation. The plan will contain providing adequate information on development of mouth ulcers, respiratory problems, cough, chest pain, unconsciousness, mood alterations, weight gain, and sleepiness. The health education plan will also contain formulation of fact sheets for the client regarding the steps that will help in planning a successful cessation program (, 2018). Congratulating the patent on self-efforts and discussing coping strategies are imperative to the plan. A discussion on specific tempting situations that increase the likelihood of smoking will help to avoid these situations. Discharge plans will be created in a way that includes several appointments with the doctors and phone contacts if required (, 2018). Further provisions that will be created in the plan include conducting mass awareness campaigns to help all individuals understand the goal of smoking cessation programs and use of nicotine replacement therapies such as, gums to facilitate easy quitting.

To conclude, it can be stated that the aforementioned steps will not only help the client Veronica accomplish her goals of quitting smoking, but will also assist the target population, composed of individuals suffering from schizophrenia to adopt the approaches that have been formulated by the government related to offering help to all individuals to stop smoking. There is a need to practice delivery of appropriate care strategies by including all aspects of cultural safety. Thus, the aforementioned cessation support that includes smoking quitting medications to patients or clients will prove effective in promoting abstinence from smoking and tobacco consumption in the long run.


Biener, L., & Hargraves, J. L. (2014). A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: association with smoking cessation and motivation to quit. Nicotine & Tobacco Research, 17(2), 127-133.

Buller, D. B., Borland, R., Bettinghaus, E. P., Shane, J. H., & Zimmerman, D. E. (2014). Randomized trial of a smartphone mobile application compared to text messaging to support smoking cessation. Telemedicine and e-Health, 20(3), 206-214.

de Vries, H., Eggers, S. M., & Bolman, C. (2013). The role of action planning and plan enactment for smoking cessation. BMC Public Health, 13(1), 393.

Durazzo, T. C., Meyerhoff, D. J., & Nixon, S. J. (2013). Interactive effects of chronic cigarette smoking and age on hippocampal volumes. Drug & Alcohol Dependence, 133(2), 704-711.

Evins, A. E., Cather, C., Pratt, S. A., Pachas, G. N., Hoeppner, S. S., Goff, D. C., … & Schoenfeld, D. A. (2014). Maintenance treatment with varenicline for smoking cessation in patients with schizophrenia and bipolar disorder: a randomized clinical trial. Jama, 311(2), 145-154.

Featherstone, R. E., & Siegel, S. J. (2015). The role of nicotine in schizophrenia. In International review of neurobiology (Vol. 124, pp. 23-78). Academic Press.

Gronlund, C. J. (2014). Racial and socioeconomic disparities in heat-related health effects and their mechanisms: a review. Current epidemiology reports, 1(3), 165-173. (2018).  The New Zealand Guidelines for Helping People to Stop Smoking. Retrieved 30 March 2018, from

Iasevoli, F., Balletta, R., Gilardi, V., Giordano, S., & De Bartolomeis, A. (2013). Tobacco smoking in treatment-resistant schizophrenia patients is associated with impaired cognitive functioning, more severe negative symptoms, and poorer social adjustment. Neuropsychiatric disease and treatment, 9, 1113.

Jha, P., & Peto, R. (2014). Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), 60-68.

Lerman, C., Gu, H., Loughead, J., Ruparel, K., Yang, Y., & Stein, E. A. (2014). Large-scale brain network coupling predicts acute nicotine abstinence effects on craving and cognitive function. JAMA psychiatry, 71(5), 523-530. (2018). Tobacco Smoking and Mental Health. Retrieved 30 March 2018, from

Ministry of Health NZ. (2018). Annual Update of Key Results 2016/17: New Zealand Health Survey. Retrieved 30 March 2018, from (2018).  DHB Toolkit-Tobacco Control.  Retrieved 30 March 2018, from$FILE/tobacco-control-toolkit.pdf

Murray, C. J., & Lopez, A. D. (2013). Measuring the global burden of disease. New England Journal of Medicine, 369(5), 448-457.

Nayan, S., Gupta, M. K., Strychowsky, J. E., & Sommer, D. D. (2013). Smoking cessation interventions and cessation rates in the oncology population: an updated systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery, 149(2), 200-211.

Reynolds, P. (2013). Smoking and breast cancer. Journal of mammary gland biology and neoplasia, 18(1), 15-23.

Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 163(8), 622-634.

Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. Bmj, 348, g1151.

van der Deen, F. S., Ikeda, T., Cobiac, L., Wilson, N., & Blakely, T. (2014). Projecting future smoking prevalence to 2025 and beyond in New Zealand using smoking prevalence data from the 2013 Census. The New Zealand Medical Journal (Online), 127(1406), 71.

Waterhouse, U., Roper, V. E., Brennan, K. A., & Ellenbroek, B. A. (2016). Nicotine ameliorates schizophrenia-like cognitive deficits induced by maternal LPS exposure: a study in rats. Disease models & mechanisms, 9(10), 1159-1167.

Zwar, N. A., Mendelsohn, C. P., & Richmond, R. L. (2014). Supporting smoking cessation. BMJ, 348, f7535. is the best
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