This chapter of the thesis is focused on providing enriching discussion based on the results retrieved from analysis of the paper in this thesis against the published researches that have been focused on health promotion and electronic cigarette cessation in pregnant women. This chapter includes critical discussions for the themes identified in this research and asserts their significance with an evidence-based approach. This chapter will also include the identified limitations that have affected the overall quality of the thesis and could be improved. The experience and reflection of the researcher in the conduct of this thesis has also been summarized in this chapter.
4.2 Critical discussion of Theme 1
The existing perceptions and the need for health promotion strategy were analyzed in the first theme. Several smoking cessation tools have been used for traditional cigarettes. However, even with the identification of several potential harms of electronic cigarettes, the availability of a prominent health promotion strategy is limited. Li et al. (2018) have worked on severe impacts of e-cigarette smoking on the maternal health and have revealed that maternal smoking during pregnancy causes several gestational complications and severely impacts the cardiovascular health of the mothers. The study also asserts that the e-cigarettes or vapours contain toxic fumes of chemicals like formaldehyde in conjunction with several carcinogenic molecules and nitrosamines. For flavouring in these cigarettes, compounds like diacetyl are used that break into benzaldehydes and can serve to be fatal for the health of both, mother, as well as the child. These compounds have been rendered toxic as they can induce cellular toxicity, oxidative stress, and inflammation in the bodies of females bearing the fetus. However, in terms of electronic cigarettes, application this and similar researches have been widely limited by the perception that electronic cigarettes are relatively healthier and less toxic. Cattannoet al. (2019) have argued in their study that physicians often fail to assess and question the impact of e-cigarettes on the patient and therefore, the assessment and discussion with accurate knowledge delivery about the health condition are not shared accurately. Therefore, there is a need of improvement in the smoking cessation counselling and development of new educational materials that are focused on the impact of e-cigarettes, more specifically in individuals with high risks such as pregnant women and individuals with pulmonary complexities. The study asserts that the educational material should possess tailored information about the use of e-cigarettes to be effective and to be comprehensible to the smokers about the potential harms of use for an informed decision making and promotion of the health. Therefore, several educational strategies and tools have been applied in conjunction with counselling as “educational tools” to promote smoking cessation programs. The research in this thesis directly correlates the need for cessation and health promotion strategy to the perception of harm. Therefore, the development of health promotion and education tools is needed to eliminate the risks of electronic cigarettes in pregnancy.
4.3 Critical discussion of Theme 2
The extensive need for a developed health promotion strategy is also needed to educate the patients and make them understand the need for cessation and the potential hazards of electronic cigarettes. This research shows that the perceptions developed by the individuals affect their ability to understand the threats associated with electronic cigarette consumption. These perceptions have been developed due to the marketing of electronic cigarettes as relatively healthy and safer alternatives. It has been identified that the impact is multimodal and affects both the mother as well as the fetus. Rollins et al. (2020) have asserted the impact of e-cigarette consumption in pregnant women in light of dependency and mental health. The mental health of the mother is directly associated with the wellbeing of the child. The study by Rollins et al. (2020) highlights that prolonged use of e-cigarettes can also affect the mental health of gestational women. Contrary to the belief that e-cigarettes can be beneficial for the individuals who are trying to quit smoking, the use of e-cigarettes has been found to be triggering dependencies in some cases and also affect the overall happiness and state of mind of the consumers. The study by Bhaleraoet al. (2019) asserts that it has been particularly difficult to generate awareness regarding e-cigarettes with the existing notions and classifications of the e-cigarette smoke. The study focuses that the policies have been developed through targeted marketing for efficacy. In the United States, the effective policy, ENDS is being used as a primary policy for the cessation of the e-cigarettes among the consumers. This policy focuses on targeted marketing. These policies have been mildly effective but have not been able to counter the need of the consumers regarding the tobacco products (Camenga et al., 2018). The health concerns associated with the e-cigarette consumption directly impacts the health of the fetus and therefore can affect the health of the younger generation and result in several long term congenital and epigenetic health consequence (National Academies of Sciences, Engineering, and Medicine, 2018). Kennedy et al. (2017) have also worked in the same direction and focused on the assessment of global health promotion approaches for the regulation of electronic cigarettes. The study has revealed that about 68 countries possess regulations for electronic cigarette consumption with 22 countries regulating through the existing norms and legislation with 25 countries that have developed novel health promotion and e-cigarette control strategies. 7 countries had developed policies by making changes in the existing norms of literature, and 14 countries that had used both novel laws and existing regulations for the health promotion and cessation of e-cigarette consumption among the nationals. Kennedy et al. (2017) assert that these regulations have been undertaken for health promotion under the WHO tobacco-free initiative and assert on the promotion of health with the currently ambiguous impact of e-cigarettes on the health of the consumers directly. However, the impact of e-cigarettes on the health of the pregnant women and the fetal health has been explored and therefore application and regulation of these legislations are highly crucial. Therefore, it is particularly important to generate awareness regarding the health hazards and the fatality of consumption of electronic cigarettes to alter the carefree perceptions leading to its consumption and successful implementation of health promotion strategies.
4.4 Limitations of the study
A major research gap that was identified in the analysis was no information regarding “surrogate pregnancy” was found. It has been well established in most of the studies (Alpert, 2019; Schilling et al., 2019; Rollins et al., 2020) that smoking of electronic cigarettes in pregnant females is associated with cessation and stress-relieving activities. However, no mention and classification of single mothers and surrogate mothers were mentioned in any of these studies. Therefore, the collection of data and recruitment strategies with details of participants could be improved. Limited information regarding biasness for interviews was included. A comparative analysis with existing research was missing in the literature included. Age-related information was also not presented succinctly for all the participants. Most of the studies included were conducted online and were not restricted to the borders of the United Kingdom. Further, the researches that were included in the study did not directly associate with the existing health promotion strategies in particular to the electronic cigarette smoking cessation programs due to lack of data and specific studies. However, this only implies the immediate need for addressing cessation for electronic cigarettes, especially, in consideration with the pregnant women.
4.5 Researcher reflections
Before imitating this thesis, I had limited understanding of how to articulate research and draw connections to synthesize information. As I started reading through the material online, it was difficult to find reliable resources and start research. However, university resources and unit guides served to be of eminent importance in the completion of this analysis as they not only helped me guide through this thesis and the process of research, but also because I was able to gather multitudes of information and acquire skills for writing, analyzing, and interpreting the researches with an articulated frame of mind. The experience of writing this thesis has been enriching and highly informative. I am sure the acquired skills and learnings from this will be directly applicable in my future research and help me develop as a competent researcher.
4.6 Chapter Summary
This chapter provides a comprehensive discussion of the themes identified in this research and evaluates the findings against the existing research to identify and assert the significance of the results retrieved. Further, limitations of this study have also been identified which could have been improved to enhance the overall quality of this thesis. This chapter also included a brief reflection on the conduct and experience of completing this research.
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