Epidemiology Diseases (401174): A Strong Synergism of Low Birth Weight & Prenatal Smoking on Asthma | Nursing Assignment Help

July 28, 2017
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Solution Code: 1AGF

Question: Advanced Accounting Report

This assignment is related to " Epidemiology of Non-Communicable Diseases" and experts at My Assignment Services AU successfully delivered HD quality work within the given deadline.

Report Writing Assignment

Task Details:

This assignment is based on the learning objectives and concepts as described in the Unit Learning Guide. There are a total of 100 marks and this assignment will contribute 20% towards the total assessment for this subject. The marking matrix that will be used for this assignment is also attached.

Your assignment should be typed, with adequate space left between questions.  Assignments should be submitted via vUWS. Be as concise as possible in your answers, and use the number of marks allocated to each  question as a guide for how much to write.

Select a peer-reviewed journal article that illustrates the critical period model, sensitive period model, or accumulation of risk model for an association between an exposure and a non-communicable disease outcome. Complete the following questions based on the article you select.

Question 1:  Provide the reference of the article and indicate the following: (a) the life-course model illustrated, and the period in the life-course to which the exposure relates, (b) summarise the hypothesised aetiological mechanism by which the exposure is associated with the outcome, and (c) summarise the findings of the example article you selected. 

Question 2: Summarise the evidence-base that supports (or does not support) the association in the article you selected

Consider the following elements for this question:

  • -How many studies of the association?
  • -What type of studies? Based on what samples, or population-bases?
  • -Are findings across these studies consistent and coherent, particularly from studies of similar or more powerful study designs?
  • -Are the results plausible in terms of a biological mechanism?

Question 3: Summarise the key methodological limitations in interpreting the association described in Question 1, and assess the extent to which the observed association can be attributed to non-causal mechanisms. [40 marks]

Consider the following elements for this question:

  • -Is there a temporal relationship between exposure and outcome?
  • -Is there a strong relationship between the exposure and the outcome?
  • -Is there a dose-response relationship between exposure and the outcome?
  • -Is the outcome measure affected by selection and/or measurement bias?
  • -Is the exposure measure affected by selection and/or measurement bias?
  • -Are the results likely to be affected by confounding?
  • -Are the results likely to be affected by chance variation?


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Solution: A Strong Synergism of Low Birth Weight and Prenatal Smoking on Asthma in Schoolchildren

The article illustrates accumulation of risk model as an example of life course model. The study depicts that prenatal smoking exposure is associated with impaired lung function or chronic obstructive disease in adulthood.

The study recruited school going children those who were exposed to smoking as one of the main risk factor for impairment of lung functions. The school going children aged 12 years were followed up to validate the association of risk factor (s) and development of lung disease (s) later in life. It is hypothesized that exposure during prenatal time period is associated with chronic non communicable diseases at later stage of life. Additive effects of other risk factors can also be observed.

The current study depicts strong relation of smoke (exposure) and asthma & airway inflammation (result) among school children.  It also analyzes that smoking functions as risk factor for low birth weight (LBW) so study participants were recorded with LBW.

The study findings reported that study participants exposed to smoking were found with low weight of 3360 gram (mean birth weight) while control group showed mean weight of 3571 gram.  A statically significant association was noticed for prenatal exposure and impaired lung function. Children with low birth weight were found higher risk of development of lung diseases during adulthood (95% confidence interval, risk ratio – 8.8). The study results were obtained by adjusting other known risk factors – allergic sensitization, airway inflammation etc.


It is evident from the other research studies that obstruction of lung activities at later stage of life could be associated with duration of pregnancy. The study results are consistent with the above journal article.

Another study depicted that strong relationship between lower birth weight and impaired lung function among adults. The research paper analyzed lower birth weight as an important risk factor for asthma. A cohort of 381 subjects were followed and data were collected till the age of 45-50 years. The stated study also adopted accumulation of risk model.

Also evident from the studies that lower birth weight and weight gain during early childhood increase the chances of asthma problem. There is a strong relation between prenatal risk factors and lung impaired activity.

The above cited studies shows strong association of exposure and outcome. Most of the research studies are sample based but research is going on to provide enough evidence based upon population studies. It can be seen from the studies that the results are similar and produces coherent findings. Study defines the results in terms of biological action as various processes occur during exposure to risk factor which give arises to clinical signs and symptoms during adulthood.   

Study Limitations

It is evident from the research study that there is strong relationship between exposure (prenatal smoking) and outcome (impaired lung activity). The study results are in coherence with the biological nature of the disease. Temporal sequence of association was also observed where smoking precede lung impairment. The study does not depict any information related with biological gradient as the exposure happened during prenatal hence does-response cannot be observed.  

One of the main study limitation is underreporting about the smoking habit of the pregnant mothers recruited initially to observe exposure - outcome association. Social stigma associated with smoking could be the main factor for underreporting. This would definitely lead to under estimation of relation of exposure and outcome. It is highly likely that selection of mothers with different level of smoking could produce different results, for example over estimation of exposure-outcome relation among mothers with high frequency of smoking and vice-versa. In the similar line, children could be exposed to varying degree of exposure which might has an impact on association.

The confounding factors were adjusted to observe true relation between smoking and lung obstruction. It is known that these factors have additional impact on exposure-outcome association. For example, allergic sensitization leads to biological reactions for asthma hence this interaction with exposure might produce false results. Definitely, chance variation affects study results. Biological changes during gestational period might show result variation and outcome cannot be defined as results of smoking exposure.   

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