RosasL_Assignment#4b

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Rubric for Article Critique Reports Week 4 – Assignments 4b Assignment 4 (4b) Part Question Answer Points Title 1.Title of the article, journal name, your name Title: Hot Tea Consumption and Its Interactions with Alcohol and Tobacco Use on the Risk for Esophageal Cancer Journal: Annals of Internal Medicine Lynda Rosas 3 Purpose/Research problem 2a. What is the purpose of the study? Is it clearly identified? Is the research problem important? Primary goal - To examine the association that Hot Tea Consumption and its interaction with alcohol and tobacco use on the risk for Esophageal Cancer Secondary goals: - To examine hazard ratio for Esophageal Cancer cofounded or modified with tea temperature preferences (by either alcohol consumption and/or tobacco smoking) - To explore the joint association of tea temperature preferences, alcohol consumption and smoking with Esophageal cancer Yes, the purpose was clearly identified. Yes, this is an important research problem because it brings awareness of the risk associated with esophageal cancer in correlation with tea, alcohol and/or smoking consumption. 5 2b. Identify the dependent variable(s) Esophageal Cancer 3 2c. Identify the independent variable(s) Hot Tea Consumption & the use of Alcohol and Tobacco 3 Literature review 3a. Are the cited sources relevant to the study? Yes. 3 3b. Does the literature review offer a balanced critical analysis of the literature? Yes. 3 3c. Are the cited studies recent? Yes. All are cited studies are within the past 10 years. 3 Theoretical framework* 4a. Has a conceptual or theoretical framework been identified? No conceptual or theoretical framework was identified. 3 4b. If yes, is the framework adequately described? N/A 3

Design and procedures 5a. Identify the study design used in this study? Make sure that you select the exact type of design used, i.e., one of the three discussed this week. China Kadoorie Biobank, a prospective cohort study 5 5b. Is the study design appropriate to answer the research question? Yes, given that the objective is to assess the association and not the causality. 3 5c. What type of sampling design was used? Stratified cohort sampling 5 5d. Was the sample size justified on the basis of a power analysis or other rationale? No, sample size was not justified on the basis of a power analysis. 5 5e. Are the inclusion and exclusion criteria clearly identified? What are they? Inclusion criteria: - Adults aged between 30 and 79 years - Valid baseline data (included completed questionnaire) - Physical measurements - Written informed consent Exclusion criteria: - Persons with previous diagnosed cancer - Missing data of body mass index - Lost to follow-up shortly after baseline - Persons that reduced their tea or alcohol intake from at least weekly to less than weekly - Former smokers (stopped within the last 6 months or more) 5 5f. What measurement tools were used for the dependent variable(s)? Esophageal Cancer was measured using the following: - Incident cases among participants form the time enrolled by linking to local disease and death registries and to the national insurance system, as well as by active follow-up. - Trained staff, blinded to the baseline information which coded all cases using the International Classification of Diseases, 10th Revision ( defined by code C15) - Retrieval of medical records from participants with ongoing incident cases which the trained staff review for diagnosis validation and collect additional clinical information, such as pathology subtype. 5 5g. What measurement tools were used for the independent variable(s)? Hot Tea Consumption: methods included a baseline questionnaire which asked participants to report usual frequency of drinking during the past 12 months (such as # of days, # of cups consumed per day, volume of tea leaves each time & #of times they were changed the leaves per serving, 5

and the type of tea consumed) Alcohol Consumption: methods included a baseline questionnaire which asked participants to report who used alcohol at least once a week in the past 12 months (how often typically consumed, type of beverages habitually intake, and the amount of alcohol consumed on a typical drinking day) Tobacco Consumption : methods included a baseline questionnaire which asked ever-smokers (such as how many times per day, what type and amount of tobacco used) and former smokers (how long had it been since quitting, for example: if less than 6 months would be consider as a current smoker) 5h. Were validity and reliability issues discussed? Dependent variables : demonstrated a linkage between high-temperature tea drinking and esophageal cancer risk when the participants smoked and consumed alcohol, which enhances the validity and reliability of the measures Independent variables: In the absences of excessive alcohol and tobacco consumption, there isn’t a correlation of daily tea drinking with esophageal cancer risk However, the strengths of the study was its prospective design that included a population geographically spread across urban and rural China and carefully adjusted for potential confounders to avoid reverse causality bias. 4 Ethical considerations 6a. Were the participants fully informed about the nature of the research? Yes. Participants were informed about the nature of the research since there was written informed consent given by each individual. 3 6b. Were the participants protected from harm? Yes. No participants were reported to have been harmed in this study since it only pertained to questionnaire information gathered in regards to the association of tea temperatures and its interactions with alcohol and tobacco consumption in esophageal cancer risk done in a clinical environment. 2 6c. Was ethical permission granted for the study? Yes. The Ethical Review Committee of the Chinese Center for Disease Control and Prevention (Beijing, China) and the Oxford Tropical Research Ethics Committee, University of Oxford (United Kingdom) approved the study. 3 Data analysis 7a. What type of data and statistical analysis was undertaken? The following methods were undertaken to report date and statistical analysis: - Baseline Questionnaire (continuous responses) o Included covariates such as sociodemographic 3

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characteristics - Statistical Analysis - Cox proportional model (discrete responses) - Multivariable logistic model - Linear trend (continuous variable) - Sensitivity analysis 7b. Was the statistical analysis appropriate to address the research question? Yes, the statistical analysis was appropriate in addressing the research question because demonstrated the association tea temperatures and its interactions with alcohol and tobacco consumption in esophageal cancer. 2 Results 8. What are the results of the study? Did the results answer the research question(s)? A correlation was shown between drinking hot tea and the risk of esophageal cancer, depending on the amount of alcohol and tobacco consumed. Drinking hot tea in combination with drinking or smoking is associated with a higher risk of esophageal cancer than drinking hot tea alone. 5 Discussion 9a. Were the findings linked back to the literature review? Yes. The authors critically explore the similarities and differences in findings between the study and the literature demonstrating the association. 3 9b. Did the authors identify study limitations? What were they? The author identified the following limitations: - Tea-drinking patterns were self-reported and collected once, at baseline, although consumption habits may change over time. - Tea temperatures relied on qualitative self-report data and were not validated by actual measurement. - Participants weren’t asked about the sip size along with the initial tea temperature, which can determine intraesophageally temperature and led to differences in subjective perception of temperature - The lack of information regarding the histologic subtype of each esophageal cancer case - Hot tea drinking may have a correlation with other beverages and foods at high temperatures which information was not collect or adjusted in the analysis. 5 9c. Do you think the limitations are serious enough to impact the internal and external validity** of the study? The limitations of the study do not pause a serious threat to the internal validity of the study. However, the identical sample does pause questions about the generalizability of study findings to other factors such as (people with multiple comorbidities, mental health status, educational background, etc.) 3 Overall assessment 10. What is your overall assessment of the study? The overall assessment of the study was to understand if either tea, alcohol &/or smoking had a correlation to Esophageal cancer. 5

Total 100 Source: Coughlan M, Cronin P, Ryan F. Step-by-step guide to critiquing research. Part 1: quantitative research. Br J Nurs . 2007;16(11):658-63. * A conceptual or theoretical framework/model is a representation of a concept and the relationships between this concept and other variables that might impact it or be affected by it. It provides structure to a study and a rationale for the different relationships between the variables. Not every study has to have a conceptual or theoretical framework clearly outlined. The better research questions are usually the ones informed by theory and a corresponding framework. For an example, check the following article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934012/ ** The validity of a study, in contrast to the validity of measurements, is the degree to which study results are accurate and well-founded, when account is taken of study methods, representativeness of study sample, and nature of the population from which it is drawn. - Internal validity (results are attributed to hypothesized effect and not sample differences) - External validity (generalizability)