Running Head: RELATIONSHIP BETWEEN E-CIGARETTES AND COPD 1RELATIONSHIP BETWEEN E-CIGARETTES AND...

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Running Head: RELATIONSHIP BETWEEN E-CIGARETTES AND COPD     1
RELATIONSHIP BETWEEN E-CIGARETTES AND COPD         21

A RESEARCH STUDY ON THE RELATIONSHIP BETWEEN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND E-CIGARETTES AMONG 18-30YEAR OLD AMERICAN POPULATION
Anand Jeevanandam
Capstone Project
In partial fulfillment of the degree Master of Public Health
National University
05/31/2020
I accept this capstone project on behalf of the Community Health Department, School of Health and Human Services, National University.
__________________________________________ XXXXXXXXXX___________
Faculty/Professor of Capstone                    Date
Brandon Eggleston PhD
__________________________________________ XXXXXXXXXX___________
MPH Program Director                        Date
Steve Bowman PhD
A research study on the relationship between chronic obstructive pulmonary disease and
e- cigarettes among 18-30year old American population.
Health Issue: Chronic obstructive pulmonary disorder (COPD)
Target Group:18-30yr old American adults
Data Source: PMC, CDC
Table of Contents
Abstract    5
INTRODUCTION    6
Effects of E-cigarettes    6
Rate of Use    7
Preventive Measures    8
LITERATURE REVIEW    9
Chronic Obstructive Pulmonary Disease (COPD)    9
Overview    9
Symptoms    10
Diagnosis    10
Treatment    10
E-Cigarettes    11
Effects of E-Cigarettes    12
Usage of E-Cigarettes    12
Reason for the Use of E-Cigarettes’    13
Association of COPD and the Use of E-Cigarettes    14
METHODS    16
Research Questions    16
Research Method    16
Inclusion Criteria    16
Exclusion Criteria    17
Limitations    17
RESULTS    18
Summary of Articles    20
DISCUSSION    27
Discussion of Findings    27
Use of E-cigarettes    27
COPD and the Use of E-Cigarettes    29
CONCLUSION    31
Limitation of the Study    31
References    32
Abstract
The research conducted in this paper focuses on determining how the use of e-cigarettes is related to chronic obstructive pulmonary disease (COPD). The study focused on young people aged between 18 to 30 years in America. E-cigarettes are commonly used among young people ad have replaced the traditional cigarettes due to their attractive flavors. The use of cigarettes is linked to the destruction of the lungs. COPD is an inflammatory illness that affects the lungs and blocks airflow and it is highly related to the use of e-cigarettes as they affect the lungs. The study focused on analyzing the rate of the use of e-cigarettes among young Americans and the number of people that have acquired COPD from smoking e-cigarettes. The research method used in the study was a systematic review and the target population was Americans aged 18 to 30 years old. The data was collected from various databases such as NCBI and EBSCO to get previous studies that had addressed the research questions. The findings of the study were that over 90 percent of youth and college students had tried using e-cigarettes at least once in their life. The rate of using e-cigarettes has increased from 1.5 percent in 2011 to 20 percent in 2019 and the rate of using e-cigarettes is expected to rise in the future as more young people use e-cigarettes. Most studies linked the use of e-cigarettes to the presence of COPD among users due to harmful components in e-cigarettes that can damage the lungs. For instance, a study indicated that there was a 75 percent possibility of e-cigarette users having COPD compared to non-cigarette smokers. Others, however indicated that e-cigarettes are safe among smokers and can be used to minimize the effects of COPD because it is less harmful than traditional cigarettes. The limitation of the study is the lack of many studies focusing on the research topic hence not enough information to conclude that e-cigarettes cause COPD.
INTRODUCTION
Electronic cigarettes (e-cigarettes) are cigarettes that have a battery, a place to hold a liquid and a heating element. They are also known as vape pens, e-cigs, tank systems as well as electronic nicotine delivery systems (ENDS) (National Institute on Drug Abuse, XXXXXXXXXXThey produce an aerosol when one heats the liquid in them. The aerosol contains nicotine, chemicals, and flavorings and this is what smokers inhale into their lungs (CDC, XXXXXXXXXXE-cigarettes are not only used to smoke nicotine as they also deliver drugs such as marijuana. The contents of the e-cigarette aerosol are harmful as the flavoring has chemicals such as diacetyl that is related to chronic lung disease, cancer-causing chemicals and heavy metals such as lead, tin, and nickel.
Smoking is fatal due to complications such as chronic obstructive pulmonary disease (COPD). COPD is a condition where there is continuous inflammatory responses that make a person have respiratory failure, minimized lung function decline among other respiratory symptoms (Polosa et al., XXXXXXXXXXA study presented at the American Thoracic Society indicated that e-cigarette users are twice likely to have COPD which means that there is a strong relationship between COPD and using e-cigarettes (Perez et al., XXXXXXXXXXStopping conventional tobacco has been linked to enhancement of the prognosis of COPD and it reduces the chances of developing and consequently perishing from tobacco-related diseases.
Effects of E-cigarettes
Various health effects are linked to e-cigarettes. The presence of nicotine in e-cigarettes leads to high addiction among users, it is toxic to fetuses and harms young adult and adolescent
ain development (CDC, XXXXXXXXXXThey are also linked to lung cancer due to the chemicals used in the aerosol. The use of e-cigarettes also makes the use of other drugs pleasurable to young people and may influence the youth to start smoking other drugs. Also, e-cigarettes smoking has carcinogenic emissions that can be exposed to second-hand smokers and pose health risks to them. Based on a report by Johns Hopkins Medicine researchers, a person who uses e-cigarettes is six times more at risk of developing COPD compared to one that does not use any tobacco products which shows the risk of using e-cigarettes (“Vaping increases odds,” XXXXXXXXXXE-cigarettes accelerate the progression of COPD as they stimulate inflammation and damage of lungs.
Rate of Use
The use of e-cigarettes has increased rapidly in recent years as the users were seven million in 2011 and increased to 41 million in 2018. Euromonitor expects the number to rise to 55 million by 2021 globally (Jones, XXXXXXXXXXAccording to the Center for Disease Control for Prevention (CDC), e-cigarettes are highly used by young people. In 2019, 27.5 percent of high school students and 10.5 percent of middle school students used e-cigarettes within 30 days (CDC, XXXXXXXXXXMost of the e-cigarette users are cu
ent regular smokers at 58.8 percent and only 11.4 percent of e-cigarette users have not been previous regular smokers. Also, adults who were e-cigarette users in 2017 were 2.8 percent of American adults. Based on a Pew Research, the number of secondary students vaping nicotine in the U.S. doubled from 2017 to 2019 such as 12th graders increasing from 11 percent to 25 percent while 10th graders increased from 8 percent to 20 percent (Schaeffer, XXXXXXXXXXMany people have been seeking tighter rules on the use of e-cigarettes based on 64 percent of people in a July 2019 Gallup Survey (McCarthy 2018).
Based on gender, females start using e-cigarettes from influence from friends and family members while male users start using e-cigarettes as a way of quitting smoking for health concerns (Pineiro, XXXXXXXXXXMale users continued the use of e-cigarettes as they enjoy it while females use e-cigarettes to manage moods and reducing stress. The high rate of e-cigarettes usage in the U.S. is influenced by several factors. Tsai et al XXXXXXXXXXindicate that the main reasons why students choose to use e-cigarettes include the availability of e-cigarettes in different flavors, influence from a family member or friend and the perception that e-cigarettes are less harmful than conventional cigarettes.
    The high and increasing rate of e-cigarettes is an indication that COPD cases may end up increasing in the coming years. It is a concern that the health sector as well as education institutions should consider addressing to prevent future cases of the illness.
Preventive Measures
    The use of e-cigarettes should be controlled the same as the use of normal cigarettes is done. It should be banned in schools and areas where young people congregate to discourage its use among the youth (Murthy, XXXXXXXXXXThere should be sensitization programs to help young people understand that cigarettes are as risky as normal cigarettes. Adults especially family members and friends should also play a part in it as they part of people who influence young people to engage in e-cigarettes use.
LITERATURE REVIEW
The literature review section focuses on how various researchers have addressed COPD, e-cigarettes as well as their relationship among young users. The chapter has discussed the overview, symptoms, diagnosis and treatment of COPD. It has also indicated details on e-cigarettes, its usage and effects. Finally, the section focuses on how e-cigarettes are linked to COPD.
Chronic Obstructive Pulmonary Disease (COPD)
Overview
COPD is a chronic inflammatory illness of the lungs that obstructs airflow from the lungs. It comprises of progressive lung illnesses such as chronic
onchitis and emphysema. Emphysema destroys the elastic fibers and fragile walls of the alveoli which makes small airways to collapse when one
eathes out (Miravitlles & Ribera, XXXXXXXXXXChronic
onchitis on the other hand na
ows and inflames the
onchial tubes which produced more mucus thus blocking the airways. Most COPD patients experience both chronic
onchitis and emphysema however the severity of each condition differs from one person to another.
COPD is mainly caused by tobacco smoking however it can also be prevalent among people who burn fuel for heating and cooking in poorly ventilated areas (Hardin et al., XXXXXXXXXXA person’s lungs relies on the natural elasticity of the air sacs and
onchial tubes to remove air out of the body and if they lack enough elasticity mainly caused by COPD, some of the air is trapped in the lungs when exhaling. People who are also exposed to second-hand smoke are also at risk of COPD however the prevalence of COPD among them is lower as COPD is riskier when one inhales smoke.
Symptoms
COPD signs and symptoms include lack of energy as body cells lack adequate flow of air in the body. A COPD patient wheezes persistently, has shortness of
eath especially during physical exercise and experiences frequent respiratory infections (Roche, Chavannes & Miravitlles, XXXXXXXXXXAlso, he or she swells in the legs, experiences chest tightness, has chronic cough that is mostly accompanied by sputum and some have unexpected weight loss. People who have mild symptoms may not notice the health condition however there are times when the symptoms become severe and one has to seek medical attention to control them.
Diagnosis
According to the World Health Organization (WHO), the diagnosis of COPD is done through spirometry, a test that measures how fast air move in and out of the lungs as well as how deeply a person can
eathe (WHO, XXXXXXXXXXIt is a test conducted on people the severe symptoms of COPD. Other methods to diagnose COPD include arterial blood gas test that measures the amount of ca
on dioxide and oxygen in the blood, a chest CT scan or a chest X-ray.
Treatment
There is no cure for COPD and the best way to manage the illness is through treatment of the symptoms as well as lifestyle changes. Treatment of

anand-final-dqb4ficy.docx

Tanaya · Accepted Answer

Running Head: DISSERTATION		1
DISSERTATION		11
ROLE OF MAINTAINING GOOD PATIENT AND PHYSICIAN RELATIONSHIP TO RUN THE HEALTHCARE INDUSTRY IN A BETTER WAY
(DISSERTATION)
ACKNOWLEDGEMENT
It gives me immense pleasure in completing my research dissertation, titled as “ROLE OF MAINTAINING GOOD PATIENT AND PHYSICIAN RELATIONSHIP TO RUN THE HEALTHCARE INDUSTRY IN A BETTER WAY”. This topic has helped me gain ample knowledge on the concepts and importance of billboard advertising and customer buying behaviour. 
I want to acknowledge the assistance of all the people who had helped me complete this research successfully. I would wish to show my gratitude towards my supervisor, who had helped me extensively in this study and without whose support; I would not have been able to finish this research. Without their support and response, this study would not have been possible. Lastly, I would also express my thankfulness to my friends and family whose encouragement has assisted me during my research. 
Thanking you all,
_____________________.
Abstract
The study highlights the importance of the role of patient and physician relationship, and the extent the hospital contributes to building this relationship so that the care and interventions provided to the patient can be improved. The various aspect like trust, communication and loyalty with knowledge, experience and empathy reflected by the physician enhances the relations in between the patient and physician. To augment this relationship, there are several initiatives taken by the hospitals and healthcare institutes. The study explores the different initiatives in terms of technology, infrastructural changes, investments on developing the communication skill of the physician are taken up by the healthcare. This will help the relationship flourishes and the patient acknowledges the importance of the physician in the decision-making process. The issues that the physician face in maintaining this relationship and the extent the decision-making process of the patient have been studied. 
Table of Contents
Chapter 1: Introduction	5
Introduction	5
Background of Study	5
Significance of Research	6
Problem Statement	7
Rationale of Research	7
Research Aim	8
Research Objectives	8
Research Questions	8
Structure of Dissertation	9
Chapter 2: Literature Review	10
Introduction	10
Trust in between Physician-patient relationship	10
Determinant of Trust	11
Patient Engagement Framework	12
Effective communication in maintaining relationship in between patient and physician	14
Communication, Trust and patient satisfaction	15
Seeking health information impacting patient-physician relationship	16
Summary	17
Chapter 3: Research Methodology	19
Research Methods	19
Research Onion	19
Research Onion	19
Research Paradigm	20
Chapter 4: Results	24
Chapter 5: Discussion	33
Chapter 6: Conclusion	37
References	38
Chapter 1: Introduction
Introduction
As the healthcare sector proceeds to become a more consumer-centric turn, the needs of the patients have also evolved.  Patients mostly does not just look for physicians who will visit them and provide a cure for their disease rather, they look for physician who will assist in building a patient-provider relationship that will contributing a positive experience for the patient. The role of patient and physician relationship has become one of the important milestones for a quality healthcare.  Survey concerning the demands of the patient reveals that the patient-physician relationship is crucial in any healthcare settings. It has been observed that the patient looks for physicians who are knowledgeable and listens intently to the concerns of the patient. Healthcare organizations have been continuously evaluating and trying to meet the needs of the patient so that they can facilitate positive experience in patients. However, often it has been observed there be certain challenges that creates barrier in building an effective patient-physician relationship. This can be a regulatory demands or challenges in interpersonal relations or the type of caregiving style which the patient is expecting. 
Background of Study
The patient and physician relationship revolves around Trust and vulnerability. As mentioned by Samuel et al. (2019), it represents a  consensual relationship where the patient knowingly gain assistance of the physician while the physician knowingly accepts the individual as a patient. It is a fiduciary relationship where the physician is aware of the patient’s autonomy and respects their confidentiality. The physician explains the patient the treatment options and obtains an informed consent before proceeding with the treatment process. The standard of care provided in this kind of collaboration are observed to be one of the best highest standards. However, often it is observed that the patient reveals secrets and fear to their physician which they do not feel confident in sharing with their family or friends (McWilliams, 2018). 
Hence, the physicians play a very crucial role in ensure that the trust ins build with the patient so that an effective relationship in between the patient and physician can be developed for regaining the patient’s health as well as well-being. There are four key aspects that have contributed in building an effective relationship between the patient and physician this includes mutual knowledge, loyalty, Trust and regard. The knowledge of the physician helps in building the Trust and faith of the patient. The patient gains confidence on the competence and level of care provided by the physician. As a result, the patient informs and report the symptoms and their beliefs to the doctor. Loyalty and Trust help the patient in forgiving certain inconvenience of the physician.
 Significance of Research
As noted by Kilbride & Joffe (2018), the knowledge of the physician in handling the ailments and emotional condition of the patient are closely associated with whether physician is capable of resolving the ailments. The communication quality often impacts on the management and the history-taking of the patient. The process by which the physician communicates with the patient have the ability to influence the patient to come back to same healthcare to the same physician. In addition, higher is the quality of the communication that exists in between the physician and the patient, higher will be chances that the physician will be willing to help in the decision-making process for the treatment of the patient. The patient will rely more on the information that will be provided by physician regarding the treatment programs and the explanatory model and perception of the diseases. Hence, this study will be beneficial in understanding the important of the role of the physician and patient’s relationship in the care planning of the patient and how the hospital can optimize this relationship so that the best treatment program can be provided to the patients.
 Problem Statement
Patient satisfaction have been defined by the degree at which the individual will be impacted by the health care services that the best care services can be provide. It has been long observed that the knowledge, Trust, loyalty and regard play an important role in influencing the relation between the physician and the patient. The four aspect that needs to be evaluated in understanding the role of physician and patient relation. This includes patient's factors, mismatch factors, systemic factors sand the patient and physician factor.  Is the fact of maintaining a good, healthy patient and physician relationship plays an important role in operating the healthcare industry in the best way possible?
Rationale of Research
What is the issue?
The main aim of the hospitals and healthcare is to improve the quality of patient care so it can achieve the patient’s satisfaction. It is often observed that the role in between the patient and the physicians play a crucial role in providing the quality care (Brick, Scherr & Ubel, 2019).  This quality of care is often determined by the competence of the physician, their efficiency, effectiveness of their operating system and infrastructure. However, there are certain barriers in building the patient-physician relationship which needs to be evaluated.
Why is it an issue?
The role of the patient and physician in a healthcare setting are often faced with barriers that impact on the patient care. This can be malpractice, violation in the medical litigations, lack in following the healthcare regulation and lack in the patient-oriented care which needs a comprehensive hospital setting. 
Why is it an issue now? 
The current problems in the hospitals and healthcare are both medical as well as non-medical factors that highlights on the lack of a comprehensive system concentrating on improving the infrastructure of the health care with affordable treatment process with high quality care including high cost recovery.
1.5 Research Aim
The purpose of the study is to identify the importance of the role of patient-physician relation in the care and treatment process. The study will also involve in identification of the barriers in care process of the patient and building this relationship.
1.6 Research Objectives
· To understand the extent communication and Trust plays a role in physician-patient relationship
· To analyze the various issues that impact the relationship between patient and physician
· To evaluate the extent the patient and physician relation helps in providing patient satisfaction through quality healthcare
· To identify the strategies adopted by the healthcare centers in maintaining a healthy patient and physician relationship and overcoming the issues
1.7 Research Questions
· What is the extent communication and Trust will play a role in maintaining physician and patient relationship?
· What are the various issues that impact the relationship in between patient and physician?
· What is the extent the patient and physician relationship provide patient satisfaction in healthcare services?
· What are the strategies that needs to be adopted by the healthcare centers so that the issues impacted on the relationship between the patient and physician can be overcome?
1.8 Structure of Dissertation
Chapter 2: Literature Review
Introduction
In the last few years there had been a change in the patterns within the society related to the medical care advances and in the accessibility of the medical information. These aspects have impacted on the relationship in between the patient and the physician. Initially physicians were accepted to be the receptacle in medical knowledge as well as in the patient management. Often medical knowledge has been treated as a commodity in between the patient and the physician. Based on this the treatment processes are customized on the basis of individual patients.
 As expressed by Mattingly, Tom, Stuart and Onukwugha (2017), a good relationship in between the physician and the patient involves providing some of the high-quality care. In addition, as mentioned by Huisman, Joye and Biltereyst (2019), communication as well as Trust are some of the key elements that helps in building a healthy relationship. As suggested by Huisman, Joye & Biltereyst (2019), effective communication plays an important ingredient in success within the healthcare field. The various social changes with the advancement in the medical technology impacts on the patient-physician relationship. Several evaluations have been carried out by the healthcare settings so that a quality service delivery can be provided with appropriate patient management. 
Trust in between Physician-patient relationship
Trust is one of the important components as well as fundamental aspect of the doctor and patient relationship. Trust builds on an understanding that the person is honest and will not inflict any harm. With the rapid proliferation of the information related to health in internet, a greater number of patients are turning towards the internet for the source of information and acquiring knowledge about their health from the internet rather than from the professionals (Pellegrini, 2017).  Patients have become more empowered and have become more inclined towards taking health-decisions on their own. There is a preconceived notion that the physicians should behave in a certain manner. The patient expects that the healthcare provider is a competent individual who is compassionate, empathetic, dependable, honest and interested for the good will of the patient (Huisman, Joye and Biltereyst (2019). This supports to the better health outcome of the patients. The patients are often observed to be put in vulnerable situations where the physicians are expected to make profits in the interest of the patients. 
It is crucial that the patients should trust and believe the physicians and can easily discuss about their private discussion, so the physician can help them in managing their physical condition. Trust in many cases within the medical field can be considered with the institutional Trust or with interpersonal Trust. Within any healthcare system, Trust is built on the interpersonal relationship in between the physician and the patients, which can either be sustained or can be damaged based on the encounters with the healthcare providers. While the institutional Trust of the patients is built on the medication system that are followed by the healthcare settings. The relationship in between the patient and the physician are often influenced by the social system and the personality with the Trust exists through framework of interaction that are often influenced by social and personality system.
Determinant of Trust
As expressed by Agarwal and Sharma (2017), despite the importance of Trust, it can be a complicated subject which are based on various perspectives. According to Tan & Goonawardene (2017), Trust can be explained based on different theories and there are several theories that have evolved in explaining Trust in between the patient and the physician. As explained by Pearson et al., the Trust of the patient can be categorized in to different subscale. These subscales are correlated based on the assessment of the patients that are carried out on the communication between the patient and the physician, based on the type of interpersonal treatment in between the individuals and the knowledge of the patients. Although there had been a close correlation of Trust observed relying on the longitudinal continuity in between the patient and the physician. Further, other aspect includes preventive counselling and the financial access of the patient for care. 
The sociocultural context is another factor that gave rise to trust. This influence the Trust of the patient in the physician based on the physicians’ behaviour, their perceived level of comfort, personal involvement in between the physician and the patient. Only lesser extent of the patient's Trust relies on the appearance and cultural competence of the physician.  As opined by Mattingly, Tom, Stuart and Onukwugha (2017), irrespective of the sociocultural determinant, the patient and physician concordance helps in building better Trust As highlighted by Berger, Bulmash, Drori, Ben-Assuli and Herstein (2020), a fruitful trust in between the patient and the physician are maintained as well as developed. 
Communication is a type of dimension that drives the physician behaviour on which the Trust of the patient is based. Further, the current technologies that are utilized by the patients and the physicians in interacting information plays an important role in physicians’ responsibilities. The online findings of the patient should align with the diagnosis, assessment and the treatment suggestions that are made by the physicians. Once the satisfaction is achieved, the Trust in strengthen with the strengthening of the relation of the patient and the physician. 
Patient Engagement Framework
The patient engagement framework has been gaining too much attention in their everyday practices of health care. This is one method by which most of the healthcare organization built in patient and physician relationship through effective and effective. The concept related to the patient engagement are been received by the policy makers positively. There are several factors that contributes in the patient engagement are mostly inspired based on sociological as well as public health perspectives (Pellegrini, 2017). The patient-related factors focus on the individual-related factors based on the age, level of education, ethnicity, income level and also personal disposition. These factors play a very crucial role in the management of the healthcare which can impact on way each individual engages with their physical during the medical pathway. This engagement is governed by the seriousness of the disease,

Running Head: RELATIONSHIP BETWEEN E-CIGARETTES AND COPD 1 RELATIONSHIP BETWEEN E-CIGARETTES AND COPD 21 A RESEARCH STUDY ON THE RELATIONSHIP BETWEEN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND...

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